Conservative treatment of ingrown toenail

ABSTRACT

Ingrown toenail or onychocryptosis or unguis incarnates is a common health problem affecting generally young adults and result in a lot of discomfort and a significant morbidity. Though a variety of methods have been adopted including conservative treatment, nail excision and partial complete matrixectomy, but to date no ideal treatment exists. Although conservative management was first described in the eighteenth century and has been reported sporadically since, only a few doctors treat their patients in this way. There is, however, a distinct place for this highly effective, low cost method as the initial treatment of these patients without the need for hospital referral. The study was carried out on 25 patients with 29 ingrown toenails in whom there is over curvature of the nail plate as one of the etiological factors for that condition. The central portion of the nail is scrapped using a scalpel making it more pliable at edges and corners so could be lifted from heaped soft tissues over. After that the patients were instructed to cut their nail straight and to repeat the procedure of scrapping, they have been learned, when need supervenes. In patients not benefited from this simple technique wedge resection with phenol matrixectomy was performed for them. The patients' age ranged from 10 to 53 years with a mean age of 28 years In all patients it was the big toe that was affected. Four patients had bilateral ingrown toenail, so the sum was 29 ingrown toenails .Five patients of the twenty one with one toe affection did not satisfy by the conservative treatment and subjected to wedge excision and phenol matrixectomy. After 24 hrs, patients in whom conservative treatment was applied were able to move around. By the end of second week, they were able to attend to their normal work. Healing was complete by 4 weeks in the twenty patients. Success rate was 82.75% [24 of 29 ingrown toenails]. Conservative treatment is a worthy trial for patients with ingrown toe nail especially in the early stages of the disease in which the primary cause is increased curvature of the nail. Although it needs a highly cooperative patient, it is painless, requires no anesthesia and achieves a high success rate